Thomas T. Brehm, Department of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany; I. Department of Medicine, Division of Infectious Diseases, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
Onno W. Akkerman, Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Tuberculosis Center Beatrixoord, University of Groningen, University Medical Center Groningen, Haren, The Netherlands
Raquel Duarte, EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal; Laboratório Associado para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal; Instituto de Ciencias Biomédicas Abel Salazar-ICBAS, Universidade do Porto, Porto, Portugal; Instituto Nacional de Saúde Doutor Ricardo Jorge-INSA-Porto, Porto, Portugal
Dumitru Chesov, Department of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany; Discipline of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
Olha Konstantynovska, Department of Infectious Diseases and Clinical Immunology, V. N. Karazin Kharkiv National University, Kharkiv, Ukraine; Regional Centre of Physiology and Pulmonology, Kharkiv, Ukraine; Department of Infectious Diseases, Imperial College London, London, England; LLC “FH Clinic”, Kharkiv, Ukraine
Liga Kuksa, Tuberculosis and Lung Disease Clinic, Riga East University Hospital, Riga, Latvia
Askar Yedilbayev, World Health Organization Regional Office for Europe, Copenhagen, Denmark
Christoph Lange, Department of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany; Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany; Baylor Children’s Foundation-Eswatini, Mbabane, Eswatini; Institute for Infection Research and Vaccine Development (IIRVD), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Antimicrobial stewardship (AMS) aims to optimize antimicrobial use, improve outcomes, and limit resistance. Tuberculosis (TB), causing 10.8 million cases and 1.25 million deaths in 2023, contributes substantially to the global resistance burden but has rarely been integrated into AMS initiatives. This review evaluates how AMS principles apply to TB care. Key differences include long standardized combination regimens, predominance of outpatient management, and the central role of adherence, which limit conventional AMS approaches such as empiric therapy or treatment shortening. Diagnostic stewardship, rapid drug susceptibility testing, therapeutic drug monitoring, and outcome documentation are critical to prevent treatment failure and emerging resistance. We conclude that explicit integration of TB into national AMS strategies is essential to preserve the efficacy of existing and novel TB drugs and improve patient outcomes.
